Bladder Incontinence

By Harry Tsai, M.D. –

Urinary incontinence is the involuntary loss of urine and affects over 13 million people in the U.S. The majority are women (85%).

Cause
Women: weakening of the urinary sphincter, pelvic muscles, overactivity of bladder muscle
Men: damage to the urethral sphincter usually from prostate surgery or procedure
Both: any kind of pelvic trauma, diabetes, multiple sclerosis, Parkinson’s, stroke, birth defects

Symptoms
Stress incontinence: SUI results from urinary leakage related to laughing, sneezing , coughing, straining
Urge incontinence: leakage associated with urgency and inability to control urination
Mixed incontinence: combination of stress and urge incontinence
Overflow incontinence: bladder leaks as a result of being full and there is never complete emptying
Total incontinence: the urinary sphincter is completely deficient and there is continuous leakage

Detection
Incontinence is reported to the urologist by the patient.  The degree of incontinence can be quantitated by number of pads worn, frequency of leakage, volume of urine, and total daily episodes.
Urinalysis is needed to rule out a urinary tract infection.
Post-void residual is measured to evaluate the amount of volume of urine retained in the bladder. Cystoscopy is performed to assess for any structural or sphincter damage.
Urodynamics: complex test performed in the office which measures the urinary flow rate and internal pressure of the bladder as it fills with urine, and control of the urethral sphincter muscles

Treatment
Male incontinence: absorbent products including pads, and absorbent undergarments; catheters; external collection devices known as condom catheters; surgery (male sling and artificial urinary sphincter, www.ams.com
Female incontinence: injection or bulking therapy to the urethral (Durasphere, www.colpopast.com)
Injection to bladder with botox (www.allergan.com)
Pelvic floor stimulation with the Intone device, www.incontrolmedical.com
Transurethral radiofrequency treatment of the urethral, www.lyrette.com
Surgical placement of a sling, www.colpoplast.com